Literary Psychiatric Observation and Diagnosis Through the Ages: King Lear Revisited

Alexander M. Truskinovsky, MD

Disclosures

South Med J. 2002;95(3) 

In This Article

Abstract and Introduction

Shakespeare's plays, and in particular King Lear, have been a favorite source of clinical observation and diagnosis for psychiatrists for the past two centuries. Most authors agree that the description of Lear's mental symptoms is remarkably consistent and close to life. This article summarizes previous attempts to diagnose the mental illness of King Lear, featuring, among others, such entities as mania, senile dementia, delirium, depression, and brief reactive psychosis, and offers a new diagnosis according to the modern diagnostic criteria, namely, bipolar I disorder, most recent episode manic, severe with psychotic features.

The interest of professional psychiatrists in the descriptions of insanity from Shakespeare's plays goes back in time 200 years or more. In England in 1795, Ferriar[1] recommended "Aretaeus . . . Shakespeare and Richardson" to "those who would gain a knowledge of the symptoms of madness from books." Bucknill[2] maintained in 1859 that "abnormal conditions of mind had attracted Shakespeare's diligent observation, and had been his favorite study," stating also that "on no other subject . . . has he written with such mighty power." In America, such prominent psychiatrists of the 19th century as Brigham, Ray, and Kellogg published articles and books on the diagnosis of mental diseases from the works of Shakespeare. All these authors, reviewing Shakespeare's insane characters, paid particular attention to the madness of King Lear.

In the 20th century, the play King Lear served as inspiration for numerous psychiatrists, psychoanalysts, psychologists, and gerontologists. Lear was used as a clinical case, an object of psychoanalysis, and a psychosocial model. The psychiatric diagnoses assigned to him show a remarkable variety. However, there seems to have been little communication between the authors who wrote on this subject. A review that would summarize the existing diagnostic ideas and a diagnosis in accordance with the most recent criteria are therefore in order.

Various reasons for the remarkable accuracy of Shakespeare's psychiatric descriptions have been proposed. Some authors, such as Kellogg,[3] attribute this accuracy to poetic inspiration; others, to his tremendous capacity for observation of life and for extrapolating the noticed facts to numberless ordinary and extraordinary situations, to synthesize an unmistakable "clinical picture" that would remain true to life throughout the entire existence of the characters on the pages of his plays. According to Bucknill,[2] "the peculiarities of a certain character being observed, the great mind that contains all possibilities within itself, imagines the act of mental transmigration, and combining the knowledge of others with the knowledge of self, every variety of character possible in nature would become possible in conception and delineation." Ray[4] stated that "Shakespeare, from a single trait of mental disease he did observe, was enabled to infer the existence of many others that he did not observe." The same author maintained that, contrary to the metaphysicians, who looked at the mind "in the abstract," Shakespeare looked at it "in the concrete," the logical result being the undisputed superiority of his descriptions. Along the same lines, Andreasen[5] calls Shakespeare "a 'behavioral scientist' in what is now recognized as the empirical tradition," his merits being a keen ability for observation and a literary talent.

Other authors, such as Kail[6] and Colman,[7] suggest that Shakespeare may have read some of the first tracts on mental illness available in his time, as well as the writings of his son-in-law, who was a physician. Moreover, his opportunities for observing insanity were not so infrequent as some think.[4] Many sources[2,6,8] attest to the fact that, in the time of Shakespeare, "lunatics" (as the mentally ill were commonly called then) were not strictly isolated, but, in the words of Bucknill,[2] "if their liberty was in any degree tolerable, it was tolerated, and they were permitted to live in the family circle, or to wander the country." Shakespeare himself provides the best demonstration of it in King Lear. Says Edgar:

The country gives me proof and precedent
Of Bedlam beggars, who, with roaring voices,
Strike in their numbed and mortified bare arms
Pins, wooden pricks, nails, sprigs of rosemary;
And with this horrible object, from low farms,
Poor pelting villages, sheepcotes, and mills,
Sometime with lunatic bans, sometime with prayers,
Enforce their charity. (Act II, Scene 3)

Strictly speaking, this sentence is an anachronism. The Bethlehem Hospital (also known as "Bethlem" or "Bedlam") started accepting psychiatric patients only at the end of the 14th century,[6,9] some 2,000 years after Lear's time. This statement would have been more appropriate for Shakespeare himself, since for him such beggars must have been a familiar sight. The same hospital also exposed its mentally ill patients to the public for money, which was a common practice both in England and on the Continent, providing great amusement to the spectators and severe distress to the inmates.[6,10] This circumstance the poet might have also used to advantage for his freelance psychiatric studies.

However, Shakespeare's descriptions of mental illness may have also been influenced by the contemporary theatrical conventions. The simulated madness of Edgar in King Lear shows many gross exaggerations, such as his attempts at moralizing, when he claims that his "mental illness" is a punishment for his sins. Thereby he is, according to Ray,[4] "talking so clearly about his own case, while indulging in unlimited incoherence and rambling about everything else" and showing "a strain of acute moralizing succeeded, more than once, by a trait of mental imbecility." Andreasen[5] first states that "Edgar feigns classic schizophrenia as Poor Tom," but later suggests that it was a pitfall of the contemporary convention of interpreting mental disease as a consequence of moral shortcomings, into which Shakespeare had fallen when he made Edgar deliver his self-castigating lines. Conversely, Ray[4] maintains that Shakespeare purposefully created a distorted presentation of madness, thus revealing to the trained eye an example of a factitious mental disease. Kellogg[3] is not convinced by Edgar's psychiatric symptoms either, mentioning "how admirably the genuine disease [in Lear] contrasts with the counterfeit." In his turn, Bark[11] poses a question of "how far Poor Tom's simulated madness is drawn from the simulated madness of those who pretended to be mad beggars, rather than the truly mad," thereby implying that Shakespeare either was unable to tell the difference between the two groups that he observed, or that he needed to create an image of a dramatic, exaggerating impostor, and did just that. Another possible explanation of this phenomenon may be Shakespeare's sarcastic treatment of the theatrical and philosophical cliches of the time.

Furthermore, according to Colman,[7] there existed a "stage convention whereby the fathers of adult or adolescent sons or daughters [were] usually elderly, and frequently irascible too." Indeed, the frequency with which such characters appear in Shakespeare's plays is striking. This description applies also to Lear. It will have an important bearing on his conduct and later, on his madness. Thus, Colman[7] advises us to keep in mind that no matter how life-like in some aspects, the characters under study are not real people, and inferences regarding their personality types or their psychiatric history should be discouraged.

Contrary to this point of view, Brigham,[12] who was one of the pillars of American psychiatric thought in the middle of the 19th century, maintains that "the insane . . . [Shakespeare] has described are not imaginary characters, but may now be found in every large Asylum." He then proceeds to enumerate such characters as Macbeth, Hamlet, King Lear, and Ophelia, as they would appear in his hospital (the State Lunatic Asylum in Utica, NY).

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